Individual
JOHN BRYAN STUPPY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Contact information
Practice address
2891 CLARK CT, SANTA FE, NM 87507-5179
(505) 930-4550
(505) 474-4550
Mailing address
2891 CLARK CT, SANTA FE, NM 87507-5179
(505) 930-4550
(505) 474-4550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3419
NM
1041C0700X
Clinical Social Worker
Primary
I-6160
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53052552
—
NM
05
—
60759364
—
NM
Enumeration date
09/13/2005
Last updated
01/17/2008
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